Licence to Cut

In Civilisation, us interns used to fight over who got to do caesars. This was mostly because caesars are fun, but also because we knew that once we found ourselves in our own little Crater somewhere, we'd have to do them on our ace. In Civilisation, however, interns never, ever got to do them without at least registrar supervision, and even the medical officers first had to get their Licence To Cut (kind of like a driving licence - this was obtained by safely performing a caesar under the supervision of a consultant) before being allowed to operate on their own.

Coming to The Crater, I was pretty sure I'd cope on my own, but asked The Legend to do just one with me before my first big call, so that I knew I'd be safe. Things are quite different in The Crater - more... casual, if you will. In Civilisation, a registrar with like a hundred years' experience puts up the spinal under super-sterile conditions (often under consultant supervision), and then monitors the patient intensively while another registrar from a different specialty who, with the help of a scrub sister and and assistant or two, rips the baby out and hands him/her to yet another registrar who checks that the neonate doesn't have two heads and seems to be breathing ok.

In The Crater, The Legend puts up the spinal. Then he explains to the staff nurse about the two drugs he has drawn up. The first drug is call The Stuff in the Big Syringe, and is for Blood Pressure. The second drug is called The Stuff in the Small Syringe and is for After The Baby's Out. Then The Legend goes and scrubs, and then he does the whole operation with only the scrub sister to help, occaisionally telling Staffie to inject some of The Stuff in the Big Syringe if the monitor is making too much noise. If it really makes too much noise (ie: is broken) he tells her to switch it off. Then he chucks the baby at the labour ward sister ('Staffie! Inject The Stuff in the Small Syringe!'), who is more than capable of making sure the neonate doesn't have two heads and making damn sure it breathes properly herself.

In Civilisation, you have to do the operation an exact certain way. Like, you have to always use a certain number of instruments to clamp the edges of the uterine incision, even if the clamps are not really holding on to anything important and are kind of getting in the way anyway. And, you have to use a certain number of suture lengths, even if you don't need all of them and end up throwing half-lengths away, because it's protocol. If you don't do it this way, you are not licensed to cut. In The Crater, The Legend, supervising my first caesar, was more than happy for me to do things the way I'd learned in Civilisation, even if it wasn't his own special way. 'As long as you do it properly,' he said. This sounded reasonable to me. (When I asked him if I had a Licence to Cut he just looked at me blankly).

I'll be honest, I'm not especially comfortable doing the spinal and the caesar and the baby resus all by myself (even although I know I'm not a true Saffa Doctor until I have). But confidence is important, and it's something I feel that The Crater cultivates, and that Civilisation often seems to crush.

The labour ward is now sort-of my job, and I do a caesar almost every day. Sometimes I'm still surprised to find myself doing them - two years ago, I was still a bit nervous about suturing something as simple as a sheath. What's next? Laparotomies and thoracotomies, I hope!